Fieldwork Participant Health / Emergency Contact Form

This form is to be completed by all participants who are carrying out fieldwork away from the University.

1Personal Details > 2Emergency Contact Details > 3Health Self-Declaration
Your Name Your Name First Last
Your contact Email whilst on the Fieldwork

Identify an email address you will have access to whilst travelling internationally.
Your contact telephone number whilst on the fieldwork

Identify here a telephone number you can be contacted on whilst travelling internationally
Other means of contact whilst on the fieldwork e.g. Social Media

Identify any other means of being contacted e.g. Social Media contacts
Staff / Student Number
Fieldwork Organiser Name

Identify here who will lead the fieldwork
Fieldwork Organiser Email
Date of Departure Date of Departure / DD / MM YYYY
Date of Return Date of Return / DD / MM YYYY
UK Destination